Provider Demographics
NPI:1952020430
Name:TYSON, RUTH (LMFT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7438 FALLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1501
Mailing Address - Country:US
Mailing Address - Phone:323-388-7711
Mailing Address - Fax:
Practice Address - Street 1:7438 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1501
Practice Address - Country:US
Practice Address - Phone:323-388-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119125106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8839000904OtherPURSUIT TO WELLNESS CENTER
CA902103830OtherPURSUIT TO WELLNESS CENTER, LLC